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Fleas (Siphonaptera) are holometabolous insects with larval and adult stages that exhibit vastly different ecologies from each other. Adult fleas are parasitic and feed exclusively on the blood of a vertebrate host, whereas flea larvae do not live on hosts and consume dried faecal blood from adult fleas. Because flea larvae rely on adult flea faeces for food, excrement and eggs must fall in the same location; thus, larval density is likely high in these restricted habitats. However, the influence of larval density on the subsequent adult stage has not been examined. In the present study, we utilized egg density to investigate density‐dependent effects on larval development and adult body size in the cat flea (Ctenocephalides felis Bouché) (Siphonaptera: Pulicidae). Specifically, eggs were collected to create three different larval densities (n = 50, 100 and 150 per 56.7 cm2), and hatched larvae from all groups were fed an excess amount of adult faecal pellets. Larval development was measured by recording the proportion of eggs that developed to the pupal stage and the proportion of eggs that reached adulthood (eclosion). The body size of eclosed adults was quantified for both sexes using head length and length of the total body. We found that the number of eggs had no effect on the proportion of larvae that pupated or the proportion of larvae that eclosed; however, higher egg densities resulted in larger body sizes for both sexes. Overall, these data yield significant insight into how the ecology of larval fleas impacts the biology of the resultant adults. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of lotiglipron (PF‐07081532), a once‐daily, oral small‐molecule glucagon‐like peptide‐1 receptor agonist, in participants with type 2 diabetes (T2D) and/or obesity. Materials and Methods: Two Phase 1 randomized, double‐blind, placebo‐controlled, multiple‐ascending‐dose studies were conducted to investigate the safety, tolerability, pharmacokinetics and pharmacodynamics of lotiglipron. Results: Across the studies, 74 participants with T2D were treated for 28 or 42 days, and 26 participants with obesity without diabetes were treated for 42 days, following randomization to placebo or lotiglipron (target doses 10–180 mg/day, with dose titration to higher target doses). Most adverse events were mild (89.6%), with nausea the most frequently reported in both studies. There were no clinically meaningful adverse trends noted in safety laboratory tests, vital signs, or electrocardiogram parameters. In participants with T2D, lotiglipron resulted in dose‐dependent reductions in mean daily glucose. The 180‐mg dose was associated with least squares mean decreases from baseline in glycated haemoglobin (−1.61% [90% confidence interval {CI} –2.08, −1.14] vs. −0.61% [−1.56, 0.34] for placebo) and body weight (−5.10 kg [90% CI –6.62, −3.58] vs. −2.06 kg [90% CI –4.47, 0.36] for placebo) after 42 days; a similar magnitude of weight loss was seen in participants with obesity. The observed pharmacokinetic profile supported once‐daily dosing. Conclusions: The profile of once‐daily lotiglipron with doses up to 180 mg, as observed in these two Phase 1 studies, indicated a safety and tolerability profile consistent with the mechanism of action, with dose‐dependent reductions in glycaemic indices (T2D) and body weight (both populations) after multiple doses. Clinicaltrials.gov identifier: NCT04305587, NCT05158244. [ABSTRACT FROM AUTHOR]

This article discusses the importance of clinical practice guidelines (CPGs) and clinician confidence in using functional electrical stimulation (FES) technologies. The success of CPGs depends on clinicians' perception of their effectiveness and their confidence in using them. Some clinicians express concerns that CPGs may be too prescriptive and not allow for individual patient needs and goals. Lack of confidence in using FES technology is also a barrier, particularly for less experienced clinicians. The article suggests that improving education and training, updating guidelines, and supporting research can enhance the effectiveness of FES technologies and improve patient care. [Extracted from the article]

Public Policy Aging Rep. 2021; 31 (4): 145 - 150. doi: 10.1093/ppar/prab019 55 Xing J, Mukamel DB, Temkin-Greener H. Hospitalizations of nursing home residents in the last year of life: nursing home characteristics and variation in potentially avoidable hospitalizations. Climate change has increased the frequency and severity of weather-related disasters such as hurricanes, exposure to heat and cold temperatures, flooding events, and wildfires. Nursing home quality: a comparative analysis using CMS nursing home compare data to examine differences between rural and nonrural facilities. Applying the age-friendly-health system 4M paradigm to reframe climate-related disaster preparedness for nursing home populations. [Extracted from the article]

Despite research investment and a growing body of diverse evidence there has been no comprehensive review and grading of evidence for public health emergency preparedness and response practices comparable to those in medicine and other public health fields. The National Academies of Sciences, Engineering, and Medicine convened an ad hoc committee to develop and use methods for grading and synthesizing diverse types of evidence to create a single certainty of intervention‐related evidence to support recommendations for Public Health Emergency Preparedness and Response Research. A 13‐step consensus building method was used. Experts were first canvassed in public meetings, and a comprehensive review of existing methods was undertaken. Although aspects of existing review methodologies and evidence grading systems were relevant, none adequately covered all requirements for this specific context. Starting with a desire to synthesize diverse sources of evidence not usually included in systematic reviews and using GRADE for assessing certainty and confidence in quantitative and qualitative evidence as the foundation, we developed a mixed‐methods synthesis review and grading methodology that drew on (and in some cases adapted) those elements of existing frameworks and methods that were most applicable. Four topics were selected as test cases. The process was operationalized with a suite of method‐specific reviews of diverse evidence types for each topic. Further consensus building was undertaken through stakeholder engagement and feedback The NASEM committee's GRADE adaption for mixed‐methods reviews will further evolve over time and has yet to be endorsed by the GRADE working group. [ABSTRACT FROM AUTHOR]

Manifestations of ageism during the recent COVID‐19 pandemic call for ways to combat persistent negative views of older adults and the disparities they fuel, especially in light of the aging of populations. We discuss the pioneering Age‐Friendly University (AFU) initiative that takes a systems‐level approach and offers guiding principles for advancing age inclusivity, which in turn can combat and inoculate individuals against ageism. In particular, the principles advocate that older adults be enabled to participate in core educational activities in higher education for personal and professional development and that institutions extend aging education, research on aging, and intergenerational exchange. The need for educational institutions to be more age‐friendly has become even more clear and pressing during the pandemic, where ageism has been exacerbated. Drawing on empirical evidence, we show how AFU principles can be applied to disrupt the roots of ageism and age biases, and disparities in healthcare and work environments. Connections between the AFU initiative and the Age‐Friendly Communities, Age‐Friendly Health Systems, and Age‐Friendly Employers initiatives are suggested as a collective move toward a more age‐inclusive ecosystem that fosters the well‐being of all people as they age. [ABSTRACT FROM AUTHOR]

Pharmacogenomic (PGx) testing has emerged as a compelling strategy that clinicians can use to inform antidepressant medication selection and dosing, but the clinical efficacy of this strategy has been questioned. We systematically reviewed and meta‐analyzed clinical trials for an association between the use of PGx‐guided antidepressant therapy and depressive symptom remission in patients with major depressive disorder (MDD). We included prospective, controlled clinical trials published in English up to July 12, 2022. Data extraction and synthesis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Each trial was assessed for risk of bias and a random‐effects model was used to estimate pooled risk ratios. Thirteen trials comprising 4,767 patients were analyzed, including 10 randomized controlled trials, and three open label trials. Across all included trials, those that received PGx‐guided antidepressant therapy (n = 2,395) were 1.41 (95% confidence interval (CI) = 1.15–1.74, P = 0.001) more likely to achieve remission compared with those that received unguided antidepressant therapy (n = 2,372). Pooled risk ratios for randomized controlled trials and open label trials were 1.46 (95% CI: 1.13–1.88) and 1.26 (95% CI = 0.84–1.88), respectively. These results suggest that PGx‐guided antidepressant therapy is associated with a modest but significant increase in depressive symptom remission in adults with MDD. Efforts to address the heterogeneity in PGx test composition (i.e., genes and alleles tested) and accompanying prescribing recommendations across trials will likely reduce the uncertainty about the efficacy of PGx‐guided antidepressant therapy in the literature. [ABSTRACT FROM AUTHOR]

Positive behavior support (PBS) is an example of a disability policy that has gained international acceptance through its promotion as a means of improving personal outcomes, reducing restrictive practices, and upholding human rights. We take the situation of devolution of responsibility for restrictive practices in the Australian National Disability Insurance Scheme to examine how policies for PBS have diverged. We use references in PBS policies to study the influence of geography and interpersonal relationships in policymaking. Using a variety of network science methods, we explore what has led to the development of divergent PBS policy. The results show that only a small number of co‐cited references were used, the majority of which are not PBS‐specific, are not from Australia, and are not freely available online. Geographical patterns of reference use are evident, and brokers can be identified. This geographical divergence may have negative outcomes for people with disability, particularly those with ID who are at greater risk of not having their needs met. The methodology can be applied internationally in a variety of policy contexts to demonstrate local influences on policy development and identify opportunities to strategically effect changes. [ABSTRACT FROM AUTHOR]

Accessible Summary: Positive behaviour support is used by staff to help people with different disabilities, but we do not know what helps staff to keep using positive behaviour support.We looked at all the reports that people have written about using positive behaviour support to find out what helps staff to keep using it.We used a special way of putting everything together and found groups of important things to do with positive behaviour support, the people who use it, and things happening around them. These things can help staff use positive behaviour support better and for longer. Background: It is necessary to understand which variables successfully contribute to the adoption of positive behaviour support (PBS) in disability services if people with disability are to experience meaningful outcomes. Methods: A systematic review of the disability support literature was undertaken, and meta‐aggregation was used to synthesise the findings. The study applies ENTREQ statement criteria, and diffusion of innovations theory was used to analyse and interpret the results. Results: Twenty‐seven papers were included in the analysis, from which over 300 findings were extracted. Forty‐one aggregated findings generated a final set of 26 principles which informed the development of a conceptual framework for the adoption of PBS in disability services. Conclusion: The conceptual framework and supporting principles will assist those interested in introducing PBS into disability services for successful adoption and are applicable to researchers, managers, and practitioners alike. Recommendations are made to expand research on the application of PBS in specific disability contexts and to broaden the application of PBS beyond challenging behaviour. [ABSTRACT FROM AUTHOR]

Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans. [ABSTRACT FROM AUTHOR]

Research surrounding access to surgical care between Maori and non-Maori has grown substantially (Fig. Despite a plethora of resources outlining how to conduct safe and responsive research for Maori, non-Maori researchers with little connection to Maori communities and people continue to lead and control research on or about Maori.1 Maori health clinicians and academics tirelessly challenge these researchers and attempt to protect Maori from research that is racist, exploitative and demeaning. Within these discourses, Maori are often framed within a deficit lens in health research.8 Such deficiencies are framed as either biological or cultural, or both, due to mainstream research methodologies lacking critical reflexivity of Western systems that maintain inequities.9 Furthermore, there is limited research examining the impact of sociocultural systems developed by the dominant group on Maori health. [Extracted from the article]

Effects‐directed analysis (EDA) is used to identify the principal toxic components within a complex mixture using iterative steps of chemical fractionation guided by bioassay results. Bioassay selection can be limited in EDA because of the volume requirements for many standardized test methods, and therefore, a reduced‐volume acute toxicity test that also provides whole‐organism responses is beneficial. To address this need, a static, 7‐d, water‐only, reduced‐volume method (50 mL, 10 organisms) was developed for Hyalella azteca that substantially decreases the volume requirements of standard‐volume acute test exposures (200–500 mL of test solution, 15–20 organisms) while maintaining water quality and meeting control survival criteria. Standard‐ and reduced‐volume methods were compared by conducting concurrent toxicity tests with 2 inorganic toxicants (KCl and CdCl2) and 2 organic mixtures of naphthenic acid fraction components (NAFCs) to evaluate test performance. There was no difference between methods when comparing the median lethal concentrations (LC50s) for KCl and both NAFC mixtures (p > 0.05). The LC50s for CdCl2 were statistically different (p = 0.0002); however, this was not considered biologically meaningful because the difference between LC50s was <2‐fold. In conclusion, the reduced‐volume H. azteca test method generated results comparable to standard‐volume test methods and is suitable for use in situations where limited testing material is available, such as when conducting EDA. Environ Toxicol Chem 2020;39:2221–2227. © Her Majesty the Queen in Right of Canada 2020. Reproduced with the permission of the Minister of Environment and Climate Change Canada. [ABSTRACT FROM AUTHOR]

Introduction: The right ventricle (RV) strain measured by speckle tracking (RVS) is an echocardiographic parameter used to assess RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Doppler tissue imaging‐derived peak systolic velocity (Sʹ) in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). Methods: We enrolled consecutive patients who underwent cardiac MRI between Jan 2012 and Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, Sʹ, and FAC% were tested for accuracy to identify impaired RV EF (EF < 45% & <30%) using receiver operator curves. Results: The study cohort included 500 patients with mean age 55 years ± 18 and peak tricuspid regurgitation velocity 2.7 ± 1.4 m/s. The area under ROC for RVS was 0.69 (95% CI 0.63–0.75) and 0.78 (95% CI 0.70–0.88) to predict RVEF < 45% & RVEF < 30%, respectively. The RV FAC% had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. Conclusion: Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard. [ABSTRACT FROM AUTHOR]

Background: Percutaneous endoscopic gastrostomy (PEG) can facilitate feeding and medication administration in dysphagic patients with Parkinson's disease and related disorders. Information on survival, institutionalization, and complications post PEG might inform feeding decisions. Method: A total of 93 patients with Parkinson's disease and related disorders were identified by review of PEG registers and by searching the administrative databases in 2 large UK university hospitals (2005–2017); 83 case notes were available for retrospective review. Care processes and outcomes were assessed. Results: The following were the diagnoses: 58 (70%) had Parkinson's disease, 10 (12%) had progressive supranuclear palsy, 5 (6%) had multiple system atrophy, 3 (4%) had dementia with Lewy bodies, and 7 (8%) had vascular parkinsonism. The median age was 78 years (interquartile range 72–82); 29 (35%) were women. Care processes included a future care plan in place prior to admission for 18 patients (22%), and PEG was placed during emergency admission in 68 patients (82%). The outcomes included median survival at 422 days; 30‐day mortality rate was 6% (5 patients); and of 56 patients admitted from home, 18 (32%) were discharged to institutions (nursing or care homes). The most common complication was aspiration pneumonia for 18 (22%) of patients. Age, sex, diagnosis, admission type, comorbidities, and place of residence did not predict survival. Discharge to own home and follow‐up by the home enteral feeding team were associated with longer survival. Conclusion: We recommend markers of advanced disease should prompt advanced care planning. Discussions about PEG feeding should include information about post‐PEG survival, complications, and risk of institutionalization. Further research is needed on quality‐of‐life post PEG and ways to reduce aspiration pneumonia. All PEG patients should have nutrition team follow‐up. [ABSTRACT FROM AUTHOR]

Aims: Human genetic, tissue expression, proteomics, transcriptomics and nonclinical studies implicate tumour necrosis factor α‐like ligand 1A (TL1A) as a novel target in inflammatory bowel disease (IBD). PF‐06480605, a fully human immunoglobulin G1 monoclonal antibody, targets TL1A. This first‐in‐human, Phase 1, dose‐escalation study assessed safety, tolerability, pharmacokinetics, pharmacodynamics and immunogenicity of intravenous (IV) and subcutaneous (SC) PF‐06480605 in healthy subjects (NCT01989143). Methods: Ninety‐two subjects were randomized to single ascending doses (SAD), PF‐06480605 1 mg, 3 mg, 10 mg, 30 mg, 100 mg, 300 mg, 600 mg or 800 mg IV, or multiple ascending doses (MAD), PF‐06480605 3 × 500 mg IV, or 3 × 30 mg, 3 × 100 mg, or 3 × 300 mg SC every 2 weeks for three doses, or placebo. Safety, tolerability, pharmacokinetics, immunogenicity profiles and total TL1A, anti‐drug antibody (ADA) and neutralizing antibody (NAb) levels were assessed at pre‐determined times. Results: PF‐06480605 SAD up to 800 mg IV and MAD up to 300 mg ×3 SC and 500 mg ×3 IV were well tolerated. Overall, there were 45 and 44 treatment‐emergent adverse events in SAD and MAD cohorts, respectively, and no deaths or serious adverse events. PF‐06480605 exposure generally increased dose‐dependently. ADA and NAb levels did not impact safety, pharmacokinetics, or pharmacodynamics at higher doses. Target engagement was demonstrated through dose‐dependent differences in serum total soluble TL1A concentrations for PF‐06480605 vs placebo cohorts. Conclusions: PF‐06480605 was generally well tolerated, and binding of soluble TL1A was maintained throughout the dose interval, supporting further study of PF‐06480605 in patients with IBD and other inflammatory conditions. [ABSTRACT FROM AUTHOR]

Larval and adult mosquitoes mount immune responses against pathogens that invade their hemocoel. Although it has been suggested that a correlation exists between immune processes across insect life stages, the influence that an infection in the hemocoel of a larva has on the immune system of the eclosed adult remains unknown. Here, we used Anopheles gambiae to test whether a larval infection influences the adult response to a subsequent bacterial or malaria parasite infection. We found that for both female and male mosquitoes, a larval infection enhances the efficiency of bacterial clearance following a secondary infection in the hemocoel of adults. The adults that emerge from infected larvae have more hemocytes than adults that emerge from naive or injured larvae, and individual hemocytes have greater phagocytic activity. Furthermore, mRNA abundance of immune genes—such as cecropin A, Lysozyme C1, Stat‐A, and Tep1—is higher in adults that emerge from infected larvae. A larval infection, however, does not have a meaningful effect on the probability that female adults will survive a systemic bacterial infection, and increases the susceptibility of females to Plasmodium yoelii, as measured by oocyst prevalence and intensity in the midgut. Finally, immune proficiency varies by sex; females exhibit increased bacterial killing, have twice as many hemocytes, and more highly express immune genes. Together, these results show that a larval hemocoelic infection induces transstadial immune activation—possibly via transstadial immune priming—but that it confers both costs and benefits to the emerged adults. [ABSTRACT FROM AUTHOR]

Background: Many young people are reluctant to seek professional help for alcohol and other substance use problems, preferring to rely on family and friends. MAKINGtheLINK is a school‐based intervention that teaches adolescents how to help their peers overcome barriers to engaging with professional help. The current study examined the effect of the MAKINGtheLINK programme in a sample of 12‐ to 15‐year‐old students. Methods: Participants included 247 Grade 8 students (49% male, 51% female) recruited from 3 schools in Victoria, Australia. Participants completed questionnaires measuring barriers to professional help‐seeking, help‐seeking intentions and confidence to seek help at 3 time points (pre‐intervention, post‐intervention and 6‐week follow‐up). A non‐controlled repeated measures design was used to assess the effect of the programme on help‐seeking across time points. Results: The programme decreased barriers, increased intentions to seek help from formal sources, decreased intentions to seek help from family and increased confidence to seek help for a peer. The decrease in barriers was maintained at the 6‐week follow‐up, as were decreased intentions to seek help from family members, and increased intentions to seek help from school counsellors and alcohol and drug workers. The effects of the intervention did not differ substantially between males and females. Conclusions: The MAKINGtheLINK is the first intervention to focus on overcoming barriers to help‐seeking for substance use problems by helping adolescents develop skills to support their peers. The intervention has promise as a means of facilitating help‐seeking during adolescence, although further research is needed to test its effectiveness in a more rigorous design. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify rare causal variants underlying known loci that segregate with late‐onset Alzheimer's disease (LOAD) in multiplex families. Methods: We analyzed whole genome sequences (WGS) from 351 members of 67 Caribbean Hispanic (CH) families from Dominican Republic and New York multiply affected by LOAD. Members of 67 CH and additional 47 Caucasian families underwent WGS as a part of the Alzheimer's Disease Sequencing Project (ADSP). All members of 67 CH families, an additional 48 CH families and an independent CH case‐control cohort were subsequently genotyped for validation. Patients met criteria for LOAD, and controls were determined to be dementia free. We investigated rare variants segregating within families and gene‐based associations with disease within LOAD GWAS loci. Results: A variant in AKAP9, p.R434W, segregated significantly with LOAD in two large families (OR = 5.77, 95% CI: 1.07–30.9, P = 0.041). In addition, missense mutations in MYRF and ASRGL1 under previously reported linkage peaks at 7q14.3 and 11q12.3 segregated completely in one family and in follow‐up genotyping both were nominally significant (P < 0.05). We also identified rare variants in a number of genes associated with LOAD in prior genome wide association studies, including CR1 (P = 0.049), BIN1 (P = 0.0098) and SLC24A4 (P = 0.040). Conclusions and Relevance: Rare variants in multiple genes influence the risk of LOAD disease in multiplex families. These results suggest that rare variants may underlie loci identified in genome wide association studies. [ABSTRACT FROM AUTHOR]

Background A review of the management of acute pancreatitis ( AP) at a tertiary intensive care unit ( ICU) in Auckland, New Zealand, was published in 2004. This paper aims to update this series and identify changes in admission criteria, management and outcomes. Methods A retrospective review of patients admitted to the Department of Critical Care Medicine, Auckland City Hospital, with AP from 2003 to 2014 was undertaken and data compared with the previous study (1988-2001). Results Eighty-four patients (male 53, mean ± SD age = 56.9 ± 15 years) with 85 admissions to ICU from 2003 to 2014 were compared with 112 patients in the previous study. Maori were over-represented. Median duration of symptoms prior to admission to ICU decreased from 7 to 3 days. The proportion of total AP patients admitted to ICU halved and the mean Acute Physiology and Chronic Health Evaluation II score on admission decreased from mean 19.9 ± 8.2 SD to 15.4 ± 7.3 ( P < 0.001). Two thirds of patients had persistent organ failure. The use of enteral feeding doubled from 46/112 (41%) to 71/85 (84%) ( P < 0.001). The use of primary percutaneous drainage increased from 14/112 (13%) to 24/85 (28%) ( P = 0.007). Rate of necrosectomy was similar (36/112 (32%) versus 20/85 (24%), P = 0.205), although minimally invasive necrosectomy was introduced. Overall hospital mortality decreased by 29% ( P = 0.198). Conclusion There have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is a common disease for which a specific treatment remains elusive. The key determinants of the outcome from AP are persistent organ failure and infected pancreatic necrosis. The prevention and treatment of these determinants provides a framework for the development of specific treatment strategies. The gut-lymph concept provides a common mechanism for systemic inflammation and organ dysfunction. Acute and critical illness, including AP, is associated with intestinal ischemia and drastic changes in the composition of gut lymph, which bypasses the liver to drain into the systemic circulation immediately proximal to the major organ systems which fail. The external diversion of gut lymph and the targeting of treatments to counter the toxic elements in gut lymph offers novel approaches to the prevention and treatment of persistent organ failure. Infected pancreatic necrosis is increasingly treated with less invasive techniques, the mainstay of which is drainage, both endoscopic and percutaneous. Further improvements will occur with the strategies to accelerate liquefaction and through a fundamental re-design of drains, both of which will increase drainage efficacy. The determinants of severity and outcome in patients admitted with AP provide the basis for innovative treatment strategies. The priorities are to translate the gut-lymph concept to clinical practice and to improve the design and active use of drains for infected complications of AP. [ABSTRACT FROM AUTHOR]

Epidemiological studies allow healthcare outcomes, effectiveness, appropriateness and utilization to be analysed.1 Healthcare providers can then monitor data to facilitate better preventive care and provide targets for spending. Ethnic and geographic variations in the incidence of pancreatitis and post-pancreatitis diabetes mellitus in New Zealand: a nationwide population-based study. [Extracted from the article]

Background Internationally pancreatic surgery has become increasingly centralized; however, geographical and population distribution within New Zealand (NZ) limits the practicalities of such an approach. The aim of this study was to review the short-term outcomes of patients undergoing pancreatic surgery by a single hepato-pancreato-biliary trained surgeon in a centre that would meet the minimum criteria set by the NZ National Standards but not necessarily the definition of a high-volume surgeon/centre. Methods A retrospective review of consecutive patients undergoing pancreatic resection within an enhanced recovery programme by a single surgeon between March 2005 and April 2013. Primary outcomes were 30-day morbidity and 90-day mortality. Results A total of 156 patients who underwent a pancreatic resection were included. Eighty-two (53%) patients underwent a pancreaticoduodenectomy. Forty-seven (30%) underwent a left pancreatectomy. Overall, 30-day morbidity was 64% and overall 90-day mortality was 2.6%. Overall median length of stay was 11 (3-140) days. Conclusions Acceptable outcomes have been achieved for patients undergoing pancreatic resection within a centre that meets the criteria proposed by the NZ National Standards for treatment of pancreatic cancer. [ABSTRACT FROM AUTHOR]

The African elephant consists of forest and savanna subspecies. Both subspecies are highly endangered due to severe poaching and habitat loss, and knowledge of their population structure is vital to their conservation. Previous studies have demonstrated marked genetic and morphological differences between forest and savanna elephants, and despite extensive sampling, genetic evidence of hybridization between them has been restricted largely to a few hybrids in the Garamba region of northeastern Democratic Republic of Congo (DRC). Here, we present new genetic data on hybridization from previously unsampled areas of Africa. Novel statistical methods applied to these data identify 46 hybrid samples - many more than have been previously identified only two of which are from the Garamba region. The remaining 44 are from three other geographically distinct locations: a major hybrid zone along the border of the DRC and Uganda, a second potential hybrid zone in Central African Republic and a smaller fraction of hybrids in the Pendjari-Arli complex of West Africa. Most of the hybrids show evidence of interbreeding over more than one generation, demonstrating that hybrids are fertile. Mitochondrial and Y chromosome data demonstrate that the hybridization is bidirectional, involving males and females from both subspecies. We hypothesize that the hybrid zones may have been facilitated by poaching and habitat modification. The localized geography and rarity of hybrid zones, their possible facilitation from human pressures, and the high divergence and genetic distinctness of forest and savanna elephants throughout their ranges, are consistent with calls for separate species classification. [ABSTRACT FROM AUTHOR]

Cat fleas ( Ctenocephalides felis) are known as the primary vector and reservoir of Rickettsia felis, the causative agent of flea-borne spotted fever; however, field surveys regularly report molecular detection of this infectious agent from other blood-feeding arthropods. The presence of R. felis in additional arthropods may be the result of chance consumption of an infectious bloodmeal, but isolation of viable rickettsiae circulating in the blood of suspected vertebrate reservoirs has not been demonstrated. Successful transmission of pathogens between actively blood-feeding arthropods in the absence of a disseminated vertebrate infection has been verified, referred to as cofeeding transmission. Therefore, the principal route from systemically infected vertebrates to uninfected arthropods may not be applicable to the R. felis transmission cycle. Here, we show both intra- and interspecific transmission of R. felis between cofeeding arthropods on a vertebrate host. Analyses revealed that infected cat fleas transmitted R. felis to naïve cat fleas and rat fleas ( Xenopsylla cheopis) via fleabite on a nonrickettsemic vertebrate host. Also, cat fleas infected by cofeeding were infectious to newly emerged uninfected cat fleas in an artificial system. Furthermore, we utilized a stochastic model to demonstrate that cofeeding is sufficient to explain the enzootic spread of R. felis amongst populations of the biological vector. Our results implicate cat fleas in the spread of R. felis amongst different vectors, and the demonstration of cofeeding transmission of R. felis through a vertebrate host represents a novel transmission paradigm for insect-borne Rickettsia and furthers our understanding of this emerging rickettsiosis. [ABSTRACT FROM AUTHOR]

Urban stream restoration continues to be used as an ecological management tool, despite uncertainty about the long-term sustainability and resilience of restored systems. Evaluations of restoration success often focus on specific instream indicators, with limited attention to the wider basin or parallel hydrologic and geomorphic process. A comprehensive understanding of urban stream restoration progress is particularly important for comparisons with nonurban sites as urban streams can provide substantial secondary benefits to urban residents. Here, we utilize a wide range of indicators to retrospectively examine the restoration of Nine Mile Run, a multi-million dollar stream restoration project in eastern Pittsburgh (Pennsylvania, USA). Examination of available continuous hydrological data illustrates the high cost of failures to incorporate the data into planning and adaptive management. For example, persistent extreme flows drive geomorphic degradation threatening to reverse hydrologic connections created by the restoration and impact the improved instream biotic communities. In addition, human activities associated with restoration efforts suggest a positive feedback as the stream restoration has focused effort on the basin beyond the reach. Ultimately, urban stream restoration remains a potentially useful management tool, but continued improvements in post-project assessment should include examination of a wider range of indicators. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to explore the relationships among the mother's internal working model of feeding, attentional process, feeding behaviors, and responsiveness accounting for maternal psychological distress, which may contribute to preterm infants' feeding difficulties. Design and Methods In this descriptive study, 21 mother-preterm infant dyads were videotaped during feeding. Results Surprisingly, the internal working model of feeding was a significant negative predictor of maternal feeding behaviors and maternal attention. All other correlations were non-significant. Conclusions Given the early timing of the data collection, it is possible that mothers had not developed a frame of reference of their infant as a person. Research to help further understand factors and timing affecting maternal feeding behaviors is needed. [ABSTRACT FROM AUTHOR]

Previously, extracellular vesicle production in Gram-positive bacteria was dismissed due to the absence of an outer membrane, where Gram-negative vesicles originate, and the difficulty in envisioning how such a process could occur through the cell wall. However, recent work has shown that Gram-positive bacteria produce extracellular vesicles and that the vesicles are biologically active. In this study, we show that B acillus subtilis produces extracellular vesicles similar in size and morphology to other bacteria, characterized vesicles using a variety of techniques, provide evidence that these vesicles are actively produced by cells, show differences in vesicle production between strains, and identified a mechanism for such differences based on vesicle disruption. We found that in wild strains of B . subtilis, surfactin disrupted vesicles while in laboratory strains harbouring a mutation in the gene sfp, vesicles accumulated in the culture supernatant. Surfactin not only lysed B . subtilis vesicles, but also vesicles from B acillus anthracis, indicating a mechanism that crossed species boundaries. To our knowledge, this is the first time a gene and a mechanism has been identified in the active disruption of extracellular vesicles and subsequent release of vesicular cargo in Gram-positive bacteria. We also identify a new mechanism of action for surfactin. [ABSTRACT FROM AUTHOR]

Purpose To describe maternal behaviors occurring before infant regulated or dysregulated behavior at three times in early infancy and examine behavioral patterns over time with their prematurely born infants. Design and Methods Video recordings of 37 dyads were coded on infant regulated and dysregulated behaviors following maternal soothing and stimulating behaviors. Results At each time, infants showed more regulation after maternal soothing than after maternal stimulating. Further study is merited. Practice Implications Knowing infant regulation and dysregulation following categories of maternal behavior could help mothers anticipate infant regulatory or dysregulatory behavior in response to their own behavior and identify supportive caregiving strategies. [ABSTRACT FROM AUTHOR]

The Lake Ontario–upper St. Lawrence River (LOUSL) population of American EelsAnguilla rostrata(hereafter, “eels”) was once one of the most important groups of the species but is now in a state of serious decline. Given that thiamine deficiency has been observed in almost all of the top predators in Lake Ontario, we assessed the potential that a diet-induced thiamine deficiency associated with consumption of AlewivesAlosa pseudoharenguscould be involved. Muscle thiamine was measured in eels from throughout the LOUSL corridor and was compared with putative threshold effect levels established from the literature. Mirex concentrations were used to separate Lake Ontario-resident eels from non-Lake Ontario-resident eels. Stable isotope analyses of eel muscle samples and potential prey, including Alewives, were combined with mixing model software to infer the diets consumed by Lake Ontario eels. Although residence in Lake Ontario was associated with a significant decline in muscle thiamine concentration, estimated Alewife consumption by eels was unexpectedly low. Instead, mixing model results indicated that crayfish and Round GobyNeogobius melanostomuswere the major prey. Both taxa are known to contain thiaminase and have the potential to cause thiamine deficiency, but there are no reports of thiamine deficiency associated with Round Goby consumption, thus implicating crayfish. There was no recovery in thiamine levels prior to the initiation of oceanic migration. As a result, thiamine levels of Lake Ontario-resident eels prior to migration were only slightly above putative threshold effect levels for pathological and behavioral effects in Japanese EelsAnguilla japonica, but this would require confirmation with American Eels. Since thiamine levels are expected to decline further during migration, additional effects on eel behavior, reproduction, and survival seem probable. Because of panmixia, such effects—when combined with the relatively high reproductive potential of Lake Ontario-resident eels—may have consequences for the entire species. Received August 24, 2012; accepted May 28, 2013 [ABSTRACT FROM AUTHOR]

Possible factors in prejudice toward Muslims and those perceived to be Muslims were investigated. We specifically investigated cues of foreignness that may communicate threat. Using a 2 (Complexion: dark vs. light) × 2 (Dress: Middle Eastern vs. Western) × 2 (Name: Allen vs. Mohammed) between-subjects design, we expected cues of foreignness (dress and name) to have a greater impact on perceptions of targets than phenotype (complexion). Participants reviewed portraits of young men varying in the manipulated characteristics and gave their impressions. Generally, complexion did not affect perceptions, but portraits in Middle Eastern dress were rated less positively. There was a name by dress interaction in which Allen in Western dress was rated least negatively. Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to determine how mothers of preterm infants perceive the feasibility and acceptability of a guided feeding intervention. Design and Methods In this multiple case study design, feasibility was assessed by retention of participants through all intervention sessions. Acceptability was assessed with a semi-structured interview. Results Participants found the intervention useful for demonstrating and explaining behaviors that facilitate feeding, and helpful in dispelling previous, erroneous understandings about infant behaviors. Practice Implications The results are encouraging. The intervention was found to be both feasible and acceptable. The effectiveness of this intervention needs to be assessed in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to describe changes in a mother's early internal working model of infant feeding. Design and Methods In this qualitative study, 12 maternal responses to the semi-structured internal working model interview were audio-recorded, once in the neonatal intensive care unit after infants began oral feeding and once 2 weeks post-discharge. Interviews were analyzed using directed content analysis. Results A change between mothers' early and later nipple feeding experiences was identified. Practice Implications Nurses and other clinicians can help mothers understand the infant's behaviors and focus on the infant's nutritional intake while simultaneously developing a relationship with the infant. [ABSTRACT FROM AUTHOR]

Objectives To examine the hospitalization rate and mortality associated with forced mass transfer of nursing home ( NH) residents with the highest levels of functional impairment. Design Retrospective cohort study. Setting One hundred nineteen Texas and Louisiana NHs identified as being at risk for evacuation for Hurricane Gustav. Participants Six thousand four hundred sixty-four long-stay residents residing in at-risk NHs for at least three consecutive months before landfall of Hurricane Gustav. Measurements Using Medicare claims and instrumental variable analysis, the mortality (death at 30 and 90 days) and hospitalization rates (at 30 and 90 days) of the most functionally impaired long-stay residents who were evacuated for Hurricane Gustav were compared with those of the most functionally impaired residents who did not evacuate. Results The effect of evacuation was associated with 8% more hospitalizations by 30 and 90 days for the most functionally impaired residents. Evacuation was not significantly related to mortality. Conclusion The most functionally impaired NH residents experience more hospitalizations but not mortality as a consequence of forced mass transfer. With the inevitability of NH evacuations for many different reasons, harm mitigation strategies focused on the most impaired residents are needed. [ABSTRACT FROM AUTHOR]

Objectives To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. Design Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. Setting One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. Participants Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. Measurements MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. Results The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. Conclusion A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high mental health service use. Among Medicaid enrollees not receiving SSI, strongest suicide predictors were mental health hospitalization, high expenditures for physical health medications, and involuntary psychiatric examination. Findings suggest reducing involuntary psychiatric examinations and mental health hospitalizations while improving physical health may reduce suicide in the Medicaid population. Comprehensive hospital discharge planning, adherence monitoring with follow-up care, training mental health providers in assessing suicide lethality and providing adequate assessment time are all crucial to achieve these objectives. [ABSTRACT FROM AUTHOR]

Objective To investigate nursing home residents with psychiatric diagnoses who wander and who are not diagnosed with dementia. Method A national cross-sectional study was conducted in a male Veterans Administration Nursing Home Care Unit population using a retrospective review of the MDS. Results Eleven thousand six hundred and nineteen residents were identified as having a psychiatric diagnosis without significant cognitive impairment; just under 1% (n = 113) wandered. Using rare events logit regression, we determined that a diagnosis of schizophrenia/bipolar disorder or comorbid psychiatric conditions were associated with increased risk of wandering compared to residents diagnosed with anxiety/depression. Psychiatric wanderers were also more likely to, have symptoms of delirium, exhibit socially inappropriate behavior, manifest problems in decision-making, take anti-psychotic medications, and to be more independent in locomotion. Conclusions Psychiatric wanderers may be conceptualized better as exhibiting ambulatory concomitants of unremitted neurological/psychiatric symptoms or medication side effects of their treatment. Findings have implications for addressing treatable causes of wandering. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In 2005, Hurricanes Katrina and Rita devastated several Gulf Coast states and caused many deaths. The hurricane- related deaths of 70 nursing home residents—34 believed drowned in St. Rita's Nursing Home in Louisiana and 36 from 12 other nursing homes—highlighted problems associated with poorly developed and executed disaster plans, uninformed evacuation decision-making, and generally inadequate response by providers and first responders (DHHS, 2006; Hyer, Brown, Berman, & Polivka-West, 2006). Such loss of human life perhaps could have been prevented and certainly lessened if, prior to the hurricanes, policies, regulations, and laws had been enacted, executable disaster guidelines been available, vendor contracts been honored, and sufficient planning taken place. This article discusses applicable federal and state laws and regulations that govern disaster preparedness with a particular focus on nursing homes. It highlights gaps in these laws and makes suggestions regarding future disaster planning. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The authors examined the psychometric characteristics and factor structure of the Civilian Version of the PTSD Checklist (PCL-C; F. W. Weathers, B. T. Litz, J. A. Huska, & T. Keane, 1994) in elderly survivors, aged 66–90, of the 2004 Florida hurricane disasters. Confirmatory factor analyses of nine models of PCL-C structure revealed the strongest support for a 4-factor model consisting of reexperiencing, avoidance, numbing, and arousal dimensions. Future studies will be facilitated by the knowledge that the PCL-C 4-factor model appears to apply across the adult age range and a variety of posttraumatic stress disorder-producing conditions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To explore the extent of and factors associated with male nursing home residents who wander. DESIGN: Cross-sectional design with secondary data analyses. SETTING: One hundred thirty-four nursing home facilities operated by the Department of Veterans Affairs. PARTICIPANTS: Fifteen thousand ninety-two nursing home residents with moderate or severe cognitive impairment admitted over a 4-year period. MEASUREMENTS: Selected variables from the Minimum Data Set included ratings recorded at residents' admission to the nursing home (cognitive impairment, mood, behavior problems, activities of daily living, and wandering). RESULTS: In this sample of residents with moderate or severe cognitive impairment, the proportion of wanderers was found to be 21%. Wanderers were more likely to exhibit severe (vs moderate) cognitive impairment, socially inappropriate behavior, resistance to care, use of antipsychotic medication, independence in locomotion or ambulation, and dependence in activities of daily living related to basic hygiene. A sizable proportion of wanderers were found to be wheelchair users (25%) or were wanderers with dual dementia and psychiatric diagnoses (23%), characteristics that are not well documented in the literature. CONCLUSION: These results support previous clinical understanding of wanderers to be those who are more likely to exhibit more-severe cognitive impairment. Based on a statistical model with variables generated from prior research findings, classification as a wanderer was found to be associated with other disruptive activity such as socially inappropriate behavior and resisting care. Two understudied populations of wanderers were documented: wheelchair wanderers and those with comorbid dementia and psychiatric diagnoses. Future longitudinal studies should examine predictors of wandering behavior, and further research should explore the understudied subpopulations of wheelchair and dual-diagnosis wanderers who emerged in this study. [ABSTRACT FROM AUTHOR]

Objective To develop a brief informant version of the Geriatric Depression Scale for use in screening for depression in older adults. Design A scale development and validation study. Setting Internal medicine and geriatric outpatient clinics located at the James A. Haley Veterans' Medical Center and the University of South Florida Medical Center, Tampa, Florida. Participants A total of 147 patients (81 females and 66 males) and their adult informants. Measurements Self and informant versions of the 30-item Geriatric Depression Scale, NEO-FFI, and a health behaviors questionnaire. Results The 15-item informant version of the GDS was found to have sufficient internal consistency reliability (alpha = 0.86) and retest reliability (r = 0.81) to support its use as a clinical instrument. Construct validity was demonstrated by a pattern of correlations with external demographic and personality variables consistent with those of other versions of the GDS, as well as substantive correlations with these other versions. Efficacy of the GDSI-15 was found to be as good as that for the full 30-item informant version of the GDS. Conclusions The GDSI-15 may be a useful adjunct or alternative to standard screening methods in assessing patients in outpatient settings. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]